TB trials highlight needs, opportunities

Two recently announced tuberculosis study results could change approaches to treatment delivery and development, but only if funding allows the realization of the opportunities they highlight.

One of the studies was the REMoxTB trial, which set out to address the desperate need for shorter, simpler routes to cure tuberculosis, by determining if substituting the antibiotic moxiflacin for one of the other currently used drugs could cure the disease in four months instead of six. The good news, because that must always come first in trial results, is that the antibiotic’s use was shown to be safe. The bad news is that it didn’t shorten treatment. But perhaps the most promising news is that the trial laid the groundwork for future trials, some of which will likely lead to the desired result. That’s because, the study’s chief investigator pointed out, as one of the largest trials ever to try a new TB regimen, the trial left stronger research infrastructures in its wake, at the same time showing not only what could be done, but how. With 1,931 patient participants across 50 sites, nine countries, and three continents, it went where TB burdens were highest, and resources were lowest. In the process, researchers worked with communities to get both input and feedback. The process yielded information on needs and contexts that are important to developing successful products, the researchers said. All of that presents an opportunity, and an important one, because the trial, a collaboration of TB Alliance, Bayer HealthCare AG, The University College London Centre for Clinical Microbiology, and Medical Research Council Clinical Trials Unit, and the University of St. Andrews, also showed that shorter, simpler routes to curing tuberculosis are still needed. The results of the REMoxTB trial were published Sunday in the New England Journal of Medicine.

The other study, on the Rapid impact of effective treatment on transmission of multidrug-resistant tuberculosis detailed in the International Journal of Tuberculosis and Lung Disease, showed that effective treatment rendered patients with multidrug-resistant tuberculosis rapidly noninfectious. The study used guinea pigs exposed to patients with suspected drug-resistant tuberculosis who had and hadn’t been effectively treated, with more transmission occurring among the guinea pigs exposed to patients whose treatment hadn’t been effective. The good news here is that the results underscore the importance of treatment as prevention, adding impetus to the need to scale up the search for and access to effective treatments. The results also highlight the need for quicker detection of drug resistance to make effective immediate treatment possible, and highlights the importance of improved access to appropriate care and infection control for all patients who need it, as noted in this editorial by Dr. Paul Farmer and Dr. Mario Raviglione.

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